Brian Berman''s new Institute for Integrative Health seeks to "reframe the conversation"

I have been remiss in not reporting the public existence of the Institute for Integrative Health as a new part of the integrative practice landscape. Formally announced in May 2009, the Institute, founded by Brian Berman, MD,
Susan Hartnoll Berman, and a team which includes Georgetown integrative
medicine leader Aviad (Adi) Haramati, PhD and former deputy director of
NCCAM Margaret Chesney, MD (see bios of all here), states on its homepage that it is a 501c3 organization that "provides an environment for innovative thinking on
health and healthcare, fosters collaborations, and facilitates the
testing and implementation of novel solutions." The Institute plans to "challenge conventional thinking on health and
healthcare, reframing the conversation, nurturing creative solutions,
and exploring cutting-edge ideas." The Institute''s current projects
focus on re-framing the healthcare dialogue toward
health. One is a collaboration with the University of
Maryland''s Imaging Research Center, in which they are pushing "the discovery of new forms of media that
can be more effective at weaving knowledge into culture and inspiring
activity beyond the more traditional means of interaction." Berman used the $100,000 award that he received from the Bravewell Collaborative to seed this organization.

Comment: The Institute team is one
of the most potent one could aggregate in the integrative education,
research and practice arena. Berman is likely the most funded of NCCAM
researchers, with over $30-million in awards; Haramati has been, among
other things, a key force in knitting conventional educators and
researchers into dialogue with diverse colleagues from other licensed
disciplines; Chesney earned tremendous respect during her stint as,
effectively, NCCAM director when her nominal boss, Stephen Strauss, MD,
was dying of brain cancer; and Susan H. Berman is known to those who
know her as a force in her own right. It speaks well of them that they
have affiliated influential acupuncture researcher Richard
Hammerschlag, PhD (see Academic Organizations/Personnel, this Round-up issue) as one of their network
scholars. Notice the choice in language for a director of the Center for Integrative Medicine and the University of Maryland: integrative health. They explain: "There is a unique opportunity at this point in time to improve our
healthcare system through an integrative approach that values mind,
body, and spirit and blends complementary and conventional medicine." I am excited to see what this group will accomplish in our transit toward health creation.

Work yet to be done on the House side

Has the US House included licensed CAM or integrative practitioners in health reform? An examination comes up empty

Integrator reader Taylor Walsh, of MetroHealth Media,
took a close look, at my request, at HR 3200, American''s Affordable Health Choices Act of 2009, the major health reform
bill in the US House of Representatives, to see if "licensed CAM
professionals" or "integrative practitioners" or "integrative medicine"
had directly made it into the bill. The chief bill on the Senate
side has brought many in the integrative practice community into the
fold for the first time in federal policy of this nature. (See Update: IHPC, Others, Place CAM, Integrative Practices/Care in US Health Reform Legislation.)Walsh
responds: "On limited further
review, the language is noticeable for the absence of such references."
Despite coming up empty, Walsh notes potential points of access. The first
that he mentions is that the Integrated Healthcare Policy Consortium (IHPC) and
others might help make sure that the Senate''s inclusive language makes it into the reconciliation bill negotiations between House and Senate. Other potential points of access include:
a Health Benefits Advisory Committee (Section 123) which is to come up with
basic benefits designs within 18 months of the bill''s passage; and a public
health workforce assessment (Section 2252) which decides the disciplines and institutions eligible for inclusion as part of the
public health workforce, in such areas as the National Health Services
Corps. The current workforce definition, unlike that in the language on the US Senate side, does
not specifically mention "licensed complementary and alternative
medicine practitioners" or "integrative practitioners."

Comment: US Senator
Bernie Sanders (Independent-Vermont) credited IHPC''s work in educating
committee members for gaining inclusion on the Senate side. Looks like
the IHPC and others have a good deal of work ahead on the House side.
Thanks for this clarity, if disquieting, Taylor. We promise not to shoot the messenger.

Research

Patricia Herman, ND, MS, PhD - economist, researcher, practitioner

Economist researcher Herman finds 9 approaches/21 conditions for cost-savings from CAM
Preliminary results of a systematic
review of approximately 6600 articles so far yielded 9 complementary and alternative medicine (CAM) approaches and 21 conditions
where CAM has generated evidence of
not merely cost-effectiveness but of cost-savings. These findings came from the 256 studies with CAM
economic evaluations, 48 of which were deemed "high quality" and that had adequate
comparison data available. The findings, reported at the August 2009
convention of the American Association of Naturopathic Physicians, were the work of the professional who is emerging as the leading North American voice on CAM
costs: economist-practitioner-researcher Patricia Herman, ND, MS, PhD.
Herman co-authored the paper on the economics of integrative medicine
for the recent Institute of Medicine Summit on Integrative Medicine and
the Health of the Public. She reported findings from her 80% complete
systematic review of over 8,000 references. Herman''s top 9 therapies and 21 conditions are listed in this Integrator article.

Comment: It
is a shame that just 0.007 of the 6600 studies have high quality
economic data. Friends, we are guaranteeing that integration will
happen glacially. This allows most
insurers to deny that appropriate integration of "CAM" will lead to
cost savings, citing lack of evidence. Herman''s
exhaustive review, akin to finding needles in a haystack, is filling a huge gap for the
field. Hers is perhaps the most critically needed and valuable CAM research today - other than that of those researchers who have the
street smarts to ask economic questions - if we really want to change the services to which consumers have access. Herman''s database will be a
resource for all of us going forward.

The 10th anniversary celebration of NCCAM
in December 2009 will focus on natural products and mind-body medicine,
rather than some of the new directions, such as "real world outcomes,"
effectiveness research and CAM for pain conditions which NCCAM director Josephine
Briggs, MD has recently articulated. In a response to a series of written questions, Briggs explains in a letter published in the Integrator August 28, 2009 that NCCAM leadership is targeting an internal NIH
audience with the December theme. The anniversary celebration is "a special opportunity to showcase
to an audience of scientists the achievements and fascinating
scientific insights that have emerged in the past decade." But given the Obama administration''s focus on
comparative effectiveness research,
and the importance to integrative practices of showing comparative
value, is this a missed opportunity? Briggs explains that she supports
this future direction and in fact is on a "small
Comparative Effectiveness Research
(CER) committee established by the NIH leadership to direct trans-NIH
activities in this area." Briggs also notes that researching pain
conditions is expected to figure heavily in future NCCAM priorities. For Briggs''
entire informative, thoughtful and useful response, click here.

Comment: Briggs tenure as
NCCAM director has been marked by a strong commitment to connecting with the
communities of interest to NCCAM. Her letter of response, despite an
oppositional stance in my queries and an editorial line in the Integrator that
doesn''t always agree with NCCAM''s priorities, continues this welcome pattern of engagement. The
more important reality at this time is that NCCAM is beginning the
process of setting its next 5 year strategic plan. This is where commitment to
real world outcomes - such examinations which will give Herman more fodder in her cost
comparison research (see related article this Round up) - needs to be prioritized.

The Consortium of Academic Health Centers for Integrative Medicine
(CAHCIM) representing 45 North American medical schools has taken a
major step, under the leadership of Victor Sierpina, MD, president, in
hiring its first executive director. Janet Polli recently joined the
Consortium in this capacity. A note to the Integrator on the
subject states that Polli "will work closely with members and the
executive committee to set the strategic direction for the organization
and implement
the Consortium’s mission to advance the practice of integrative
medicine within
academic institutions." Polli has been a nonprofit professional for over ten
years, including working with the third largest university system in the United
States. Most recently, Polli worked as business
development manager for the Research Foundation of the City University of New
York, where she developed and launched GrantsPlus, and as director of Mentoring
USA, where she oversaw more than 30 site-based mentoring programs in New York
City. Her background includes a term as an AmeriCorps volunteer with the Day Care Action Council of Illinois. She has a Master of Fine Arts in Film/Video/New Media from
the School of the Art Institute of Chicago.

Comment:
I doubly welcome Polli into this integrative education and practice
landscape, both as Integrator publisher-editor and as her counter-part
in my other chief professional role as executive director of the Academic Consortium for Complementary and Alternative Health Care. Here''s to future collaboration, Janet! And good work, Vic (an Integrator adviser) in helping move CAHCIM to this key point.

Comment: Hammerschlag is
a rare combination of practical scientific thinking in a rarefied context, and
grounded, realistic political strategist. I had a chance to work with him
some in his ACCAHC position and we''re hoping to hold onto a sliver of
him as he makes this transition.

One of the modern naturopathic profession''s most accomplished leaders, Jane Guiltinan, ND, has been selected to head up naturopathic medicine at Bastyr University,
the Bothell, Washington-based institution which began as a naturopathic
medical school. Guiltinan''s resume includes serving in the late 1980s as
the medical director for Bastyr''s Healing AIDS Research Project, a
clinical research trial studying naturopathic therapies for HIV/AIDS
which led to Bastyr''s first NIH grant a half decade later and for which
she shared
the Blackmore International Award for Outstanding Research in Natural
Medicine
in 1990. In the mid-1990s, Guiltinan served as the co-medical director for the King County
Natural Medicine Clinic, the first publicly-funded integrated medicine clinic in
the United States, which continues to this day as Health Point. She was a co-investigator in several research studies at Bastyr and the Group Health Center for Health Studies. Guiltinan was named the 1995 Physician of the Year award by the
American Association of Naturopathic Physicians (AANP) in recognition of impact on students as a clinical educator. In 1998, she was appointed to the Board of
Trustees of Harborview Medical Center,
the region''s largest public health hospital, and is currently serving a
third
term on that board. In 2005-2007, she served a term as president of the
AANP. Her focus as a clinician has been on women''s health, disease
prevention and wellness promotion.

Comment: I view
Guiltinan''s appointment as a healing move by the institution, which has
struggled, like the handful of other universities of natural health
sciences, with breaking it solo commitment to a single profession, in
Bastyr''s case, naturopathic medicine, as it embraced education in other
disciplines and the responsibilities and possibilities from being a
multi-purpose institution. Many of Bastyr''s earlier naturopathic
graduates wanted to see a connection with its history and founders and
Guiltinan, on top of her extensive qualification, brings that richness
to her position.

Public Health

New public health/integrative medicine initiative

Center for Integrative Medicine in the Public Health
forges relationship with 13 community health clinics for integrative medicine residency program

Liz Kaltman, MPH announced on August 13, 2009 the opening of the website of the not-for-profit Center for the Center for Integrative Medicine in
Public Health (CIMPM) which was incorporated last spring. CIMPH''s mission is to improve health outcomes in
underserved communities through integrative medicine. The homepage notes that CIMPH established a partner relationship this past summer with the Coalition of Community Health Clinics,
an organization of 13 not-for-profit community health clinics in Oregon
through which it is assisting in creating residency opportunities for
naturopathic physicians, and therefore incorporation of
naturopathically-delivered integrative medicine to the underserved. The project is called the Preventive Medicine/Public Health Residency Program and is a two year residency that commences in the fall of 2010.

Linked to another multidisciplinary effort by chiropractic group

Chiropractic Health Section brokers relationship between
American Public Health Association and "US Bone and Joint Decade" The Chiropractic Health Section (CHS) of the
American Public Health Association (APHA) recently established a
relationship between two multidisciplinary entities in order to
advance the nation''s ability to grapple with the $850 billion per year
linked to musculoskeletal disorders. The CHS, founded in 1995, brought
together Georges Benjamin, MD,
FACP, FACEP (E)executive
Director of the American Public Health Association (APHA) and Toby King,
executive director of the US Bone and Joint Decade, to explore how the chiropractic profession could serve as a bridge between the two groups. After the meeting, APHA director Benjamin, MD,
stated: "I am pleased by the positive steps being made in regards to an
interdisciplinary approach" and that he "looks forward to working with"
the CHC and U.S. Bone and Joint Decade "to explore new ways to improve
prevention and treatment of
musculoskeletal injuries and disorders." Paul
Doherty, DC, incoming chair of the CHC views this as a step in the CHC
becoming a leader in chiropractic taking a larger role in meeting the
public health challenge of musculoskeletal problems. The
communication came from Integrator reader Claire Johnson, DC, MSEd,
communications chair of the CHS.
Johnson''s comments in the Integrator on the IOM Summit on Integrative
Medicine were published here. More information about the APHA-CHC is available by clicking here.

Integrative Clinics

Phaythoune Chothmounethinh, MD

Inner Harmony Group brings in U Arizona Fellow Shay as medical directorPeter Amato, founder of the Inner Harmony Group (IHG), an Integrator sponsor, shares his excitement that Phaythoune
Chothmounethinh, MD has been hired to serve as medical director for the Inner Harmony Wellness Center in Scranton, Pennsylvania. Chothmounethinh (a.k.a. Dr. Phay) is a 2009 fellow of the University of Arizona Center for Integrative Medicine where he also complete his family medicine residency. Dr. Phay as he is called (according to an IHG twitter on August 5) has also completed medical acupuncture training. While at the University of Arizona, he helped establish the first medical acupuncture clinic to be incorporated into a family medicine residency program for medical doctors. Amato''s clinic is one of the pioneering centers for integrative medicine and Amato''s lessons learned have benefited many other centers, both through presentations and consulting. Amato anticipates that Dr. Phay will also participate in the national consulting work of IHG. More on Chothmounethinh isavailable here.
Professions/Guild Politics

The American Medical Association''s Scope of Practice Partnership
(AMA-SOPP) campaign, through which the medical association is
monitoring and typically fighting against scope expansions by non MDs,
has its hands full. A chart from the AMA lists 154 separate legislative campaigns for practice expansion in 2009 from
professions ranging from psychologists, advance practice nurses and
optometrists to naturopathic doctors and chiropractors and other "CAM" disciplines. Of this legislation of concern to the AMA, 30 (19%) relate directly to the
distinctly licensed, or would-be-licensed, complementary and
alternative healthcare fields: 14 are initiatives of
naturopathic doctors, 8 of chiropractors, 6 those of certified professional midwives (homebirth-oriented direct entry midwives) and 2 involve practitioners of acupuncture and Oriental medicine. (For the complete list of 30, see this September 3, 2009 Integrator article.) The AMA-SOPP campaign, initiated in 2006, stimulated the formation of the Coalition for Patients Rights, led by advanced practice nurses including organizations representing DCs, NDs and LAcs.(See Coalition Battles AMA Campaign to "Thwart" Other Disciplines'' Scope Expansion, June 21, 2009.) The most
recent Coalition action noted on their website was a May 29, 2009 letter to President Barack Obama which argued that "the more than
three million healthcare professionals in the U.S. who are not
doctors of medicine or osteopath are critical stakeholders in the
movement to improve our nation’s healthcare." See the letter here. Again, the entire list of 30 "CAM" initiatives is here.

Comment: The AMA has
never shown any real threat to the public from the practitioners they
are seeking to restrict. The combination of the significant financial
benefits from being in the MD guild (see table under "Factoids to ponder: Salaries of conventional physicians in 2007, from JAMA," in
this Round-up) and these campaigns casts the MD guild in an ugly light
in which the concept of a service industry is thoroughly transformed
into one meant for self-service. (For the list of 6 prior Integrator articles on the AMA-SOPP, click here and scan down.)

Naturopathic physicians have made advances in numerous states toward
expanding and clarifying scope of practice, according to reports at the
August 18, 2009 House of Delegates meeting and August 22 General Membership meeting of the American Association of Naturopathic Physicians.

Oregon Under the leadership of the Oregon Naturopathic Physicians Association,
the NDs broadened their formulary and "can now prescribe almost
anything," according to Kevin Wilson, ND. He adds: "We don''t want to be
MDs but we now can be more full-fledged primary care physicians."

Hawaii Significant upgrade of a 1925 law which expands
the scope of practice for naturopathic physicians regarding parenteral
therapy, (prescription drug) formulary, and minor surgery. The new
licensing statute, according to Michael Traub, ND, "is based on modern
laws in Washington, Oregon and Montana." Passage required an override
of a gubernatorial veto in July.

Vermont
Lorilee Schoenbeck, ND reports that following changes in 2005, 2006 and
an insurance mandate in 2007, naturopathic doctors are now covered as
primary care providers and at the same rate as medical doctors by
insurers. This is the first state where naturopathic doctors are fully
recognized as providers under a Medicaid plan.

California The state''s budget pressures led to consolidation of various agencies, including moving the bureau which was charged with regulating NDs under the osteopathic licensing board. The naturopathic doctors will now have 2 representatives on that board. Work is continuing on clarifying the profession''s prescriptive authority.

New Hampshire
NDs had been left out of a general law
regarding all provider types with prescriptive authority; that the
state''s licensed naturopathic doctors have been re-inserted.

Connecticut
Passed a minor statute to amend an outdated 1922 act (like that which
had been in place in Hawaii) relative to adding continuing education
hours. This is a step toward an effort for thorough modernization such as was completed by NDs in Hawaii this year.

Comment: These advances, many of them in gaining or expanding prescriptive authority, came despite opposition to naturopathic physician scope expansion from the American Medical Associations Scope of Practice Partnership (AMA SOPP). However, according to the AMA SOPP list,
some of these efforts appear to have been under the AMA radar. In
addition, notably, the members of the AANP House of Delegates did not
hear about any expansion of licensure into any new states, a priority
of the AANP against which the AMA is fighting in at least 10 states. It appears from the success in expansion of
scope by naturopathic doctors once licensed, that once these physicians
are a known and legal part of the landscape, their respect and
political clout builds. Legislators are comfortable in giving them more
practice rights. As Simon Barker, ND, the vice president of the California Naturopathic Doctors Association joked in his comments to the AANP''s general membership: "We''re like
puppy dogs. It''s really hard not to like naturopathic doctors." The AMA''s effort to slam the door of entry to NDs may be its best strategy for keeping out this competition.

Is income envy a factor in integration?

Factoids to ponder: Salaries of conventional medical doctors in 2007, from JAMA

Medicine is a service profession. From the perspective of most human
beings, being an MD specialist, in particular, is also a most lucrative way to be in service to your fellow
humans. Integrator adviser Michael Levin recently sent me this list from JAMA, with the simple heading, "a factoid to ponder."

Comment: There is always
a good deal of argument about these kinds of listings, typically from
medical doctors who claim the averages are too high. Never-the-less,
they and the reality they attempt to describe are cause for pondering.
For instance, these data stimulate a good deal of income-envy in many
non-MD practitioners. For instance #2, one may recall that corporate law is also a service profession. A
real question is why these salaries are basically off the table in the
current healthcare reform debate. Once one moves north of general
medicine, it''s a hell of a lot of money and reflects the income inequities that are part of what is imbalanced in our culture.

The Foundation for Chiropractic Progress
announced a $1-million media blitz on August 20, 2009 which is meant to
support the role of chiropractors in healthcare reform. The 4-week
campaign, based on contributions from the organization''s 1000+ monthly
donors will reach such publications as the Wall
Street Journal, Politico, Roll Call, USA Today, and the Washington Post.
The release notes that the campaign is expected to generate over 10 million
media impressions and will reinforce the role of chiropractic care as it
impacts the delivery of quality, cost-effective health care nationwide. The ads feature individuals such as Brig. Gen. Becky Halstead (retired), likely football
Hall-of-Famer Jerry Rice, as well as, according to the release "the AMI Study by Richard Sarnat MD
revealing that regular utilization of chiropractic care could reduce overall
global health care cost by almost 50 percent."

Comment:Okay, the only nominally "CAM" profession that routinely touches the salary levels reported in the JAMA
article noted in this Round-up is chiropractic, thus generating the
financial base for a campaign like this. Give the chiropractic
profession and their state associations credit for pulling this off through their monthly commitments. A side note: I have to chuckle with the use of the "AMI
study" given the reluctance of much of the chiropractic profession to
embrace the broad-scope chiropractic medicine model of chiropractic taught at National University of Health Sciences which partnered with AMI (a.k.a. Integrator sponsor Alternative Medicine Integration Group) to create the pilot. It was that minority view, promoted by NUHS president, AMI board member and sometimes Integrator
commentator James Winterstein, DC, which allowed these chiropractic
graduates to serve as AMI''s primary care physicians. (For Winterstein''s
view, see Can Chiropractic Be "Integrative Medicine?" A Patient Survey and a University President Weigh In, August 26, 2008.)

Media

Dean Ornish, MD - medical editor for Huffington Post

Huffington Post selects Dean Ornish, MD as its medical editor

On August 10, 2009, the Huffington Postannounced that it had selected Dean Ornish, MD as the online
publication''s medical editor. Huffington Post is one of the most
significant online publications, most read by the left/progressive side
of the political spectrum.Ornish is the founder and president of the Preventive Medicine Research Institute
in Sausalito, California. He has received a raft of honors for his
breakthrough work in using a whole system, natural healthcare approach
to reversing coronary artery disease. Ornish served on the White House Commission on CAM Policy
and the planning committee of the recent IOM Summit on Integrative
Medicine. The Huffington Post kicked off Ornish''s term with Ornish''s
post, "Resuscitating Health Care Reform," and an additional post from Andrew Weil, MD, also on health reform, entitled "The
Wrong Diagnosis." Both, according to a statement from the Huffington Post on Ornish''s appointment "highlight the pivotal importance of
intensive lifestyle change and prevention in the health care reform
discussion."Ornish''s role will include reporting on wellness and
health care policy issues and helping recruit experts in these fields to
blog on Huffington Post.

Comment: This may be the first for a very influential medium to have an integrative medicine doctor as their lead health writer. Do we see anything parallel on the conservative side of the blogging/news world?

Dana Ullman, MPH

Stuck in the middle with you: Dana Ullman''s dialogue with the Washington Post a useful lesson

Homeopathic historian, writer and practitioner Dana Ullman, MPH shared with the Integrator an interesting letter exchange with Washington Post
writer David Brown which casts light on the media''s role in the
sometimes heated battle over the future of NCCAM, given the polarized
perspectives in the broader culture. At issue was Brown''s coverage of a
campaign by anti-CAM skeptics to get the Obama administration to defund the NIH National Center for Complementary and Alternative Medicine. Brown''s article was titled "Critics Object to ''Pseudoscience Center.''" Ullman started out with an email to Brown, the subject line of which was: "You got
duped in your story about the NIH''s NCCAM."

Ullman: "It is strange that you choose to give a
voice to a small group of ''fundamentalist'' physicians who are
antagonistic to anything other than conventional drug treatment. Steven
Novella''s website and blog spews venom against virtually every alternative
treatment, while rarely raising a word to the questionably effective mainstream
drugs. This website typically ignores reference to any of the many good
clinical or basic science studies show that benefit from the various
alternative treatments, while they parade any negative study as it was the
end-all for ''alternative medicine.''

"And it is even more strange that you
choose to have a naturopathic physician be your sole source of defense of the
National Center for Alternative and Complementary Medicine. Although this
naturopath is certainly a respected one, you could have quoted from any of the
100 or so professors of medicine at recently attended the Institute of
Medicine''s Summit on Integrative Medicine, but no, you purposefully chose not
to do so.

"Actually, this is not strange at all IF
you have an axe to grind and IF you want to show your own journalistic biases.

"A recent report from the Institute of
Medicine reported that one-third of Americans today take FIVE or more
conventional drugs. Please show me ONE study that shows the efficacy of
treatment of using five drugs concurrently. If you were sincerely
interested in ''science-based medicine,'' you would be writing very
different stories than your recent one.

"Today''s medicine is tomorrow''s
quackery...and today''s quackery is tomorrow''s medicine. This is not a
prediction; this is the evolution of medicine.

Brown: "Thanks for your message and sorry you didn''t like the story. As you can
imagine, there was a limited amount of space in which to describe the debate
and try to be fair to both sides. I quoted [US Senator]Harkin and [researcher Carlo] Calabrese on the
pro-NCCAM side and Salzberg and [Steven] Novella on the con side, and [NCCAM director] Josephine Briggs
in the middle. I''ve gotten critical e-mail from the NCCAM opponents, so I
couldn''t have been too far off."

Best,

David Brown National
Staff
The Washington Post

Comment: In Brown''s
accounting, nominally "objective" journalism, like politics, is a
necessary compromise where you know you are successful when no one is
fully pleased. Of course, the other phrase about the making of
legislation is that it is like making sausage. Not at all pretty.By the way, Ullman''s report on the IOM is among the best. It was recently published by Oxford University Press here in the E-CAM Journal.

Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......more

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